CKD-Anemia Flashcards
What levels of hemoglobin constitute anemia in males, females
less than 13.5 g/dl, less than 12 g/dl
In what stages of CKD does anemia become more prevalent
Stage 3 and Stage 4
How can CKD lead to anemia
decreased survival of RBCs, bleeding, declined EPO
Which anemia is an iron deficiency, which anemia is folic acid and vitamin B12 deficiency
microlytic, macrolytic
Where is erythropoietin synthesized, what does it do
kidney, initiates and stimulates the production of RBCs
What happens to cells trying to become RBCs without EPO
Apoptosis
What will replace EPO if it cannot be made in the body, how is it administered
Erythropoiesis Stimulating Agent (ESA), SC or IV
When is an ESA initiated
less than 10 g/dL
What is the goal of therapy
less than or equal to 11 g/dL
When is the rise of Hb too much in ESA therapy, how is the dose reduced when this occurs
1 g/dL over 2 weeks, reduce by 25%
T/F: The Black-Box Warning states there is an increase in the risk of death, myocardial infarction, stroke and other diseases if the lowest dose sufficient is not used
True
How should Hb be monitored when patients are on this therapy
weekly, biweekly, monthly
T/F: If hemoglobin does not respond by greater than 1 g/dl in 2 weeks, then you may increase the dose 50%
False: If hemoglobin does not respond by greater than 1g/dL in 4 weeks, then may increase dose by 25%
When would increasing the dose become futile in a patient that is using ESA therapy
No adequate response over a 12 week period
What are the ESA medications
Epoetin Alfa, Darbepoetin, Methoxy polyethylene glycol-epoetin beta
What is the order of ESA medications by half-life, how often is each dosed
Epoetin Alfa/TIW, Darbopoetin/BIW (dialysis) or QIW (non-dialysis), methoxy polyethylene glycol-epoetin beta/BIW unitl Hb stable then double dose for every month dose
When ESA therapy have resistance
Iron Deficiency, inflammation and infection, hyperparathyroidism, folic acid and vitamin B12 deficiency
T/F: If a patient has a cancer and there is a potential cure for that cancer will not receive ESA therapy
True
When uptitrating an ESA dose what is the minimum amount of time recommended to do so
4 weeks
How is iron stored in the body
As ferritin
What is the peptide that mainly regulates iron, what is its role due to a sickness
Hepcidin, inhibits iron availability for viruses and bacteria while also being a basis for anemia of chronic disease
For all stages of CKD what should the TSAT be
20%-50%
What should ferritin levels be if a patient is on hemodialysis, peritoneal dialysis or non-dialysis
greater than or equal to 200, greater than or equal to 100
T/F: If a patient is on hemodialysis than they should recieve their iron by IV only
True
When would a patient want to be on an iron supplement of some kind
When the TSAT is less than 30% and ferritin is less than 500
What is serum iron
Concentration of iron bound to transferrin
What is the total iron binding capactiy (TBIC), what level should it be at to get a more accurate TSAT
Capacity of the blood to bind iron with transferrin, greater than 200
What is the equation to solve for TSAT
(serum FE/TBIC) X 100
T/F: Looking at Ferritin levels is reliable in knowing if a patient has iron overload or anemia
False: Ferritin is an acute phase reactant that is elevated inifections or inflammatory states that can reach the thousands
What are the oral iron supplements
ferrous sulfate, ferrous gluconate, ferrous fumarate, polysacchardie iron complex, carbonyl iron
What oral iron supplement is the most popular, has the least absorbtion
ferrous sulfonate, ferrous gluconate
How much elemental iron should patients receive a day, how should patients take their supplements
200 mg, start with one tablet per day and then work up to three tablets daily
T/F: Iron can upset the stomach and therefore should be taken with food
False: Iron is best absorbed when it is not taken with food
What are the side effects of taking iron
Fecal discoloration, nausea and vomiting, diarrhea or constipation
T/F: The only CKD patients who use oral iron are usually stage 3-5 and are non-dialysis or perionteal dialysis
True
What phosphorous binder can be used to also increase iron and can be taken with foods
Ferric Citrate (Auryxia)
What drugs can decrease iron absorption
PPIs and H2RAs, cholestryramine, antacids, calcium
What drugs will be affected by iron
Levothyroxine, fluoroquinolones, mycophenolate
What medications are affected by iron and decrease absorption of iron
Tetracycline and doxycycline
When a patient has severely low iron how much IV is given for a bolus
1 gram total
T/F: IV iron is not given during a infection
True
What are the 5 IV iron formulations
Sodium Ferric Gluconate, Iron Sucrose, Iron Dextran, Ferumoxtyol, Ferric Carboxymaltose
Which IV iron formulations can possibly cause an anaphylactic reaction and must give a test dose
Iron dextran and Ferumoxtyol
Which IV iron formulation is not approved for dialysis use but is given to patients in late stages of CKD
Ferric Carboxymaltose
Out of the 5 IV iron formulations which one must be given IVPB and must be diluted and infused over a minimum of 15 minutes
Ferumoxtyol
Out of the 5 IV fromulations which one can be given IM
Iron dextran
What iron compound is added to a dialysis solution (hemodialysis only)
Ferric pyrophophate citrate (Triferic)
What is a common side effect of IV iron
Hypotension
T/F: High MMA is specific for B12 deficiency
True
